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Dermatology > Immunology > Flashcards

Immunology Flashcards

1
Q

What is the difference between an allergy and intolerance?

A

Allergy –> immune reaction usually IgE mediated

Intolerance –> non immune reaction

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2
Q

What tests do you offer to determine a food allergy?

A

Blood tests for IgE mediated antibodies

THEN Skin prick test or prick-prick test

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3
Q

Why should things like skin prick test, food challenges and atopy patch testing not be done in a primary healthcare or community setting?

A

Risk of anaphylaxis

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4
Q

If individual DOES NOT have IgE mediated food allergy, what should be done next?

A

Eliminate suspected allergen for 2-4 weeks, then reintroduce

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5
Q

If a child has cow milk allergy, what advice should be given?

A

Advice on food avoidance to breast feeding mothers

Info of appropriate hypo-allergenic formula or milk substitute to mother of formula fed babies

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6
Q

When should referral to secondary healthcare be considered in terms of a food allergy?

A

No response to diet removal of allergen
Child has confirmed IgE food allergy and concurrent asthma
Tests are negative but still strong suspicion of IgE food allergy

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7
Q

What are the 4 immunologically-mediated reactions of drug eruptions?

A

type I: anaphylactic
type II: Cytotoxic reactions
type III: Immune complex mediated reactions
type IV: T Cell-mediated delayed hypersensitivity reactions

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8
Q

Are immunologically-mediated reactions dose dependent?

A

No

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9
Q

Are Non-immunologically-mediated reactions dose dependent?

A

Can be

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10
Q

What is the most common presentation of drug eruption rash?

A

Exanthematous

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11
Q

What is the second most common presentation of drug eruption rash?

A

Uticaria

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12
Q

What kind of immunologically mediated reaction is a Exanthematous drug eruption?

A

Type IV

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13
Q

What are the signs and symptoms of a exanthematous drup eruption?

A 
Wide spread, symmetrical rash 
Mucous membranes usually spared e.g. mouth
Pruritis 
Mild fever
Onset 4-21 days after first taking drug
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14
Q

What are the indicators of potential, severe reaction?

A 
Involvement of mucous membranes and face
Facial oedema and erythema 
Widespread confluent erythema 
Fever >38.5 
Blisters, purpura, necrosis - sloughing of the skin 
Lyphadenopathy
Arthalgia 
SOB, wheezing
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15
Q

What drugs are associated with exanthematous

A 
Penecillins 
NSAIDs 
Erythromycin 
Phenytoin 
Anti-Epileptics 
Allopurinol
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16
Q

What drugs can cause Acute Generalised Exanthematous Pustulosis (AGEP)

A

Antibiotics
Ca channel blockers
Antimalarials

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17
Q

What drugs can cause drug induced Bullous Pemphigoid?

A

ACE inhibitors
Penecillin
Furosemide

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18
Q

What drug can cause Linear IgA bullous disease?

A

Vancomycin

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19
Q

What medications can cause a fixed drug eruption?

A

Tetracycline, Doxycycline
Paracetamol
NSAIDs
Carbamazepine

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20
Q

What is Steven-Johnsons Syndrome?

A

Stevens–Johnson syndrome, a form of toxic epidermal necrolysis, is a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes.

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21
Q

What is Toxic Epidermal Necolysis?

A

The disease causes the top layer of skin (the epidermis) to detach from the lower layers of the skin (the dermis), all over the body, leaving the body susceptible to severe infection. Death usually due to sepsis or multiorgan system failure

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22
Q

What is Acute Generalised Exanthematous Pustulosis?

A

Uncommon skin eruption. It is characterised by the rapid appearance of areas of red skin studded with small sterile pustules (small blisters filled with white/yellow fluid). There tend to be more disease in skin folds. Facial swelling often arises.

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23
Q

Drugs associated with phototoxicity?

A 
Antibiotics (fluroquinolones, tetracyclines) 
Thiazide diuretics 
Amioderone 
Immunosuppresents 
Antifungals
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24
Q

What are the two kinds of immune response?

A

Innate and Adaptive

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25
Q

What is the innate immune response?

A

Non specific, no memory, first line defence

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26
Q

What is the adaptive immune response?

A

Memory. highly specific, tolerance and self limiting

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27
Q

Definition of an antigen

A

A protein/peptide or polysaccharide that elicits a immune response

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28
Q

What activates Keratinocytes?

A

UV

Sensitizers

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29
Q

Once activated, what do kertainocytes produce?

A

Antimicrobial peptides (AMPs) that can directly kill pathogens
Cytokines
Chemokines

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30
Q

Is what disease are many antimicrobal peptides found on the surface of the skin?

A

Psoriasis

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31
Q

What granule characterises a Langerhans cell?

A

Birbeck granule (looks like a tennis racket)

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32
Q

What do Langerhans cells do?

A

They process lipid Ag and microbial fragments and present them to effector T cells. They help activate T cells

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33
Q

Which T cell is mainly found in the epidermis?

A

CD8+ T cells

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34
Q

What T cells are found in the dermis?

A

CD4+ and CD8+

35
Q

What do CD4+ cells do?

A

Send out cytokines which direct and instruct other cells to kill

36
Q

What do CD8+ cells do?

A

Kill infected cells directly

37
Q

Where are T cells produced?

A

Bone marrow

38
Q

Where do T cells mature?

39
Q

What does CD4+ cells produce?

A

TH1 and TH2

40
Q

What dos TH1 do?

A

Activates macrophages to destroy microorganisms

IL2, TNF

41
Q

What dos TH2 do?

A

Helps B cells to make Ab IL4, IL5, IL6

42
Q

What different kinds of dendirtic cells are found in the dermis?

A

Dermal DC

Plasmacytoid DC

43
Q

What do Dermal Dendritic cells do?

A

Involved in Ag presenting and secreting cyto/chemokines in inflammation

44
Q

What Plasmacytoid dendritis cells do?

A

Produce IFNa found in diseased skin

45
Q

What cells transmit information to T and B cells

A

Antigen presenting cells –> Dendritic cells

46
Q

What immune defence cells are found in the dermis?

A

Dendritic cells
Macrophages
Neutrophils
Mast cells

47
Q

Which immune defence cells are the effectors of the IgE mediated immune response (allery) ?

A

Mast cells

48
Q

What causes mast cells to release inflammatory mediators?

A

Binding of IgE onto the surface of the mast cell

49
Q

What preformed mediators do mast cells contain?

A

Histamine
TNF
Chymase
Tryptase

50
Q

What triggers psoriasis?

A

Environmental factors in genetically susceptible people e.g. stress, trauma

51
Q

What is Koebners phenomenon?

A

Lesions appear at site of an injury e.g. in psoriasis

52
Q

What parts of the body does psoriasis affect?

A

Skin
Nails
Joints

53
Q

What medications can aggravate psoriasis?

A

Beta blockers

Lithium

54
Q

What happens to melanocytes in Vitiligo?

A

The melanocytes are attacked by T cells

55
Q

Which hypersensitivity reaction is IgE mediated?

A

Hypersensitivity Type I

56
Q

What does hyposensitisation treatment do?

A

Make body produce IgG when exposed to allergen

57
Q

What hypersensitivity reaction is IgG mediated?

58
Q

If you were to do a skin test, what response would hypersensitivity type III give?

A

Arthus reaction (slow than TI but faster than TIV)

59
Q

Which hypersensitivity is deemed a “allergy”

60
Q

Which hypersensitivity is important in certain drug reactions?

61
Q

Which hypersensitivity is TH1 mediated? (t cell mediated)

62
Q

Which hypersensitivity gives a delayed response?

63
Q

Definition of hypersensitivity

A

Immune response that causes collateral damage to self

64
Q

Which hypersensitivity is immune complex mediated?

65
Q

What type of hypersensitivity is contact dermatitis?

66
Q

What type of hypersensitivity is graft rejection?

67
Q

What type of hypersensitivity is rheumatoid arthritis?

68
Q

What type of hypersensitivity is anaphylaxis?

69
Q

What test is performed in anaphylaxis?

A

Serum mast cell tryptase level

70
Q

How do you treat anaphylaxis?

A

Adrenaline

71
Q

How to treat allergic reaction?

A 
Avoidance
Anti-histamines 
Steroids (for inflam) 
Sodium cromoglycate (Blocks mast cell activation)
Allergy bracelete
Immunotherapy 
Eduaction
72
Q

How much adrenaline do you give to children in anaphylaxis?

73
Q

How much adrenaline do you give to adults in anaphylaxis?

74
Q

How many adrenaline pens should someone with potential anaphylaxis be given?

75
Q

How long is the onset of symptoms for type IV hypersensitivity ?

A

24-48 hours

76
Q

Patient has long history of well demarcated eczematous rash near umbilicus, what is the likely diagnosis?

A

Nickel allergy due to belt

77
Q

44 yr old surgeon with eczematous rash on hands extending to his forearms, what is the diagnosis?

A

Thiuram allergy (rubber accelarator) in nitril gloves

78
Q

Eczematous rash under both axilla, what is the diagnosis?

A

Deodorant allergy –> axillary dermatitis

79
Q

Chef comes in with first 3 fingers of left hand with red, itchy and dry skin. What is the likely diagngosis?

A

Garlic allergy

80
Q

Scuba diver comes in with whole body covered in eczematous rash, what is the likely diagnosis?

A

Diethylthiourea allergy, found in wet suits

81
Q

Teen comes back from holiday with a henna tattoo. Henna tattoo starts to get, peely and sore. What chemical is causing this?

82
Q

Child has marks all around lips, what is this most likely due to?

A

Lip lick dermatitis, skin reacting to with saliva

83
Q

Management of dermatitis?

A 
Allergen/ irritant avoidance 
Allergen/ irritant minimisation 
Emollients
Topical steroids
UV phototherapy 
Immunosuppresants
84
Q

What advice would you give someone with allergy to fragrances?

A

use hypallergenic brand or baby brands

Dermatology (10 decks)

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